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Started By
Message
Can someone explain this medical insurance/billing issue?
Posted on 1/15/15 at 1:38 pm
Posted on 1/15/15 at 1:38 pm
Keep getting the run around with OLOL and BCBS of LA...
- Went to Urgent Care facility managed by OLOL to get stitches. I have a $50 Urgent Care co-pay that I did not (nor was asked to) pay at the time of service.
- Get bill from OLOL stating I owe the full amount because I have not met my out of pocket deductible.
- No one can answer me on why I was not simply responsible for the $50 CoPay. Nor can they answer if I were to have the same services performed at an ER if I would have just been responsible for the $150 ER CoPay
- Went to Urgent Care facility managed by OLOL to get stitches. I have a $50 Urgent Care co-pay that I did not (nor was asked to) pay at the time of service.
- Get bill from OLOL stating I owe the full amount because I have not met my out of pocket deductible.
- No one can answer me on why I was not simply responsible for the $50 CoPay. Nor can they answer if I were to have the same services performed at an ER if I would have just been responsible for the $150 ER CoPay
4
Posted on 1/15/15 at 1:57 pm to Golfer
Do you have to meet a deductible before the copays are available?
Posted on 1/15/15 at 1:58 pm to LSUFanHouston
No. In Network CoPay's are exempt from deductible requirement. This was an in network service.
Posted on 1/15/15 at 2:10 pm to Golfer
quote:
In Network CoPay's are exempt from deductible requirement.
I know that is usually the case... but I've seen some strange things in the last year with all these new insurance plans being written.
Where do you get your health insurance from? If it's from work, find out whoever is the benefits advisor and call them. If you got the policy on the O'exchange... I'd just keep calling the insurer.
I wonder if something got coded wrong on he claim. If, somehow, the claim doesn't appear to be an urgent care claim.
Posted on 1/15/15 at 2:11 pm to Golfer
If your plan requires referral from your primary physician, that would explain it. Need to find that out soon because there are time limits on the referral being done.
Posted on 1/15/15 at 2:49 pm to AUjim
quote:
If your plan requires referral from your primary physician, that would explain it.
It would... but a referral requirement for urgent care would suck horribly.
Posted on 1/15/15 at 2:50 pm to Golfer
quote:
Went to Urgent Care facility managed by OLOL
this may be the case, just because they are managed by OLOL does not necessarily mean they are "in network" you need to check to see if that specific clinic is in network for your specific plan. If it is not, then the visit would be filed under your out of network portion of your policy and the deductible would apply
if this clinic is an in network for your policy and you are getting no where with the clinic, call BCBS and file a grievance
Posted on 1/15/15 at 2:52 pm to LSUFanHouston
quote:
a referral requirement for urgent care would suck horribly
Its typically not a referral in the sense that it has to occur prior to the visit. Usually these type of plans allow a set period of time after the visit to contact your doctor and have them do a retro referral.
Posted on 1/15/15 at 2:58 pm to Tigerpaw123
quote:
this may be the case, just because they are managed by OLOL does not necessarily mean they are "in network" you need to check to see if that specific clinic is in network for your specific plan. If it is not, then the visit would be filed under your out of network portion of your policy and the deductible would apply
I can't even find the LSU Health Urgent Care Clinic listed on BCBS of LA's website...
Posted on 1/15/15 at 3:00 pm to Golfer
try looking on your BCBS portal page and see if you can determine if it has been filed as in or out of network
Posted on 1/15/15 at 3:06 pm to Tigerpaw123
It says claim type "M"...
And it shows the provider as OLOLRMC Hospital. I didn't go to a hospital, nor was I admitted to a hospital.
And it shows the provider as OLOLRMC Hospital. I didn't go to a hospital, nor was I admitted to a hospital.
Posted on 1/15/15 at 3:14 pm to Golfer
did BCBS send you Subrogation paperworkork...a form asking if this was a work place injury , result of MVA or if a third party was responsible?
Posted on 1/15/15 at 3:20 pm to Tigerpaw123
Nope. First I heard from anyone was on Monday when OLOL sent me a bill for $395.00
Posted on 1/15/15 at 3:25 pm to Golfer
Did you get an EOB from BCBS?
Posted on 1/15/15 at 3:29 pm to Tigerpaw123
Nope.
Posted on 1/15/15 at 3:37 pm to Golfer
I said grievance in my previous post , but what I meant to say was an appeal, you can find an appeal letter on BCBS site, fill it out and send it in. I have been very successful with these, just provide as much info as you can
Posted on 1/15/15 at 4:21 pm to Tigerpaw123
Let us know how this plays out...
I just had a similar deal with my kid. He had to go to urgent care while he was at his grandparents house. We got a bill for the full amount as opposed to the copay because of the referral deal. Sounds like it sucks, but it helps keep your premiums down. Either way, we got his primary doc to handle the referral, the urgent care center resubmitted the claim, and boom. BCBS paid.
I just had a similar deal with my kid. He had to go to urgent care while he was at his grandparents house. We got a bill for the full amount as opposed to the copay because of the referral deal. Sounds like it sucks, but it helps keep your premiums down. Either way, we got his primary doc to handle the referral, the urgent care center resubmitted the claim, and boom. BCBS paid.
Posted on 1/15/15 at 4:43 pm to Golfer
This might sound dumb... but are you sure OLOL submitted a claim to BCBS?
Posted on 1/15/15 at 4:45 pm to AUjim
This is going to be a nightmare over $350...
Apparently LSU Health Urgent Care isn't an urgent care facility but actually a stand-alone clinic offering emergency services that are of the minor-trauma level or something like that.
So OLOL (which apparently supplies the doctors) bills it as an emergency service, despite being labeled an urgent care clinic. What a racket.
Yes, the claim is listed in BCBS's system.
Apparently LSU Health Urgent Care isn't an urgent care facility but actually a stand-alone clinic offering emergency services that are of the minor-trauma level or something like that.
So OLOL (which apparently supplies the doctors) bills it as an emergency service, despite being labeled an urgent care clinic. What a racket.
quote:
This might sound dumb... but are you sure OLOL submitted a claim to BCBS?
Yes, the claim is listed in BCBS's system.
This post was edited on 1/15/15 at 4:47 pm
Posted on 1/15/15 at 5:22 pm to Golfer
quote:
Apparently LSU Health Urgent Care isn't an urgent care facility but actually a stand-alone clinic offering emergency services that are of the minor-trauma level or something like that.
So it's a stand-alone ER?
If that's the case... wouldn't the $150 ER co-pay apply?
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